Wells criteria for pulmonary embolism

Last revised by Craig Hacking on 13 Jun 2019

The Wells criteria for pulmonary embolism is a risk stratification score and clinical decision rule to estimate the probability for acute pulmonary embolism (PE) in patients in which history and examination suggests acute PE is a diagnostic possibility. It provides a pre-test probability which, if deemed unlikely, can then be used in conjunction with a negative D-dimer to rule out PE avoiding imaging 1.

  • clinical signs and symptoms of DVT = 3
  • an alternative diagnosis is less likely than PE = 3
  • heart rate more than 100 = 1.5
  • immobilization for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5
  • previous objectively diagnosed PE or DVT = 1.5
  • hemoptysis = 1
  • malignancy (on treatment, treatment in last 6 months or palliative) = 1

Can be applied in either three tier or two tier models:

Three tier:

  • 0-1low risk
  • 2-6: moderate risk
  • >6: high risk

Two tier:

  • ≤4: unlikely
  • ≥4.5: likely

In the three tier model:

In the two tier model:

  • unlikely: consider D-dimer
  • likely: consider CTPA

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